Medicare Plan D Questions

With the increasing cost of prescription drugs and the number of medical conditions being treated, Medicare recipients must be aware of the coverage for which they are eligible. All Medicare recipients are eligible to receive prescription drug coverage through Medicare Plan Part D. Medicare recipients who do not join a Medicare drug plan will not receive drug coverage. Medicare recipients often have questions regarding Medicare Part D and how it works with their current plan.

How Does Medicare Part D Compare with the VA Prescription Plan?

• Healthcare coverage through the Veterans Administration (VA) assigns coverage based on military service and income level. Prescription coverage under VA healthcare limits coverage based on which prescriptions are listed in the formulary. Funding for VA healthcare is determined by Congress and could potentially face budget cuts, including cuts in prescription coverage, in future years. Medicare Part D allows veterans to receive the same prescription coverage regardless of income level or military service. Prescriptions can be picked up at any retail pharmacy and do not need to be listed in a formulary.

What Type of Prescription Drug Plans Are Available?

• There are two types of Medicare plans that offer prescription drug coverage. Medicare Prescription Drug Plans are offered in addition to Original Medicare Parts A or B. These plans provide coverage for prescription drugs and are managed by private companies. Medicare Advantage Plans are alternative Medicare health plans that include both Part A and Part B and are administered through private companies. If prescription drug coverage is offered through this plan, enrollees must choose this option to receive prescription drug coverage. If prescription drug coverage is not offered, enrollees can enroll in a Medicare Prescription Drug Plan.

How Does Medicare Part D Work and What Is the "Coverage Gap"?

• Enrollees in Medicare Part D receive a membership card that they will present at their local pharmacy. Enrollees will pay a deductible or copay when they pick up their prescriptions. Some plans have a coverage gap. Individuals with this type of coverage will start the year presenting their card and making a copayment when they pick up their prescriptions. When a predetermined limit is reached, the enrollee will need to pay the entire cost of the prescription until she reaches the out-of-pocket limit on her plan. Once she's reached the out-of-pocket limit, the plan will start paying for prescriptions again and she will make only the copayment.